| NPI | 1326760463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA TAYLOR WIGGINS Credentialing Agent 704-498-7736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-10-03 |